An interesting article about midwives[1] in The Wall Street Journal, shines a light on some compelling reasons why you might want to choose a midwife over a traditional doctor. The article states, “After nearly a century of progress, deliveries are now getting more dangerous rather than less so. The number of women who go into shock during childbirth has more than doubled in the past decade, and those who suffer kidney failure rose 97%. Globally, we are tied with Belarus in maternal mortality.” The article suggests that midwives may be the solution to the growing birth crisis, noting that we should remember the success story of midwives back in the 1920s. Americans had been treating birth as a medical event for years, but then Mary Breckinridge founded the Frontier Nursing Service in rural Appalachia, and healthy birth rates drastically improved in the area served by Breckinridges’ midwives in just 10 years time.

The WSJ article also notes that in recent years midwife led births[2] have taken a backseat to doctor led births, which has likely resulted in higher rates of birth interventions and a much more medically inclined maternity care process overall in America. The WSJ article suggests that midwifery care[3] vs. current American-style obstetrics could go a long way when it comes to normalizing the birth process[4] yet again. The points above have great merit, but the changing face of health care in America, not simply care providers, also plays a significant role when it comes to maternity care and birth experiences.

Image courtesy of Shutterstock

Birth Interventions Have Increased

There’s no doubt that labor and birth interventions[5] and complications have increased in recent years. In 1970, about 5% of American babies were born via c-section. Today the national c-section rate[6] has held steady at 33% since 2009. In 1985, the World Health Organization (WHO) noted that the ideal cesarean rate was around just 15%, a figure they’ve since withdrawn but they do still note that, “Both very low and very high rates of cesarean section can be dangerous.” A recent study[7] by Harris Interactive and the Maternity Center Association shows that technology-intensive labor is now the norm rather than the exception — and the study revealed that a majority of women reported having had the following interventions while giving birth: “electronic fetal monitoring (93%), intravenous drip (86%), epidural analgesia[8] (63%), artificial rupture of membranes surrounding the baby (55%), bladder catheter for drainage of urine (52%), and stitching to repair an episiotomy or tear (52%).” On top of this, about half the women in the above study noted that their caregiver tried to induce labor[9], most commonly through the use of drugs not natural methods. These are extremely high birth intervention rates, but they may not all be the fault of doctors vs. midwives.

Image courtesy of Shutterstock

Why are Birth Intervention Rates so High?

Increased medical care for both labor and births causes much debate. What we do know is that one major study shows that having a nurse-midwife vs. a doctor[10] is likely to reduce your risk of mortality and morbidity related to cesarean and other birth interventions, result in much fewer labor and birth interventions — and midwife led births mean fewer birth recovery complications for mothers. However, this is assuming the mother is healthy to begin with, and it’s assuming that a mother-to-be chooses to have fewer or no medical interventions during labor and childbirth[11]. Healthy mothers-to-be are well-suited for midwifery care and even home birth[12] and normally have excellent results with both choices. However, women today give birth later in life[13], which can cause complications. Many women[14] today are becoming pregnant while overweight[15] or obese[16] and many more women than ever have heart disease[17] — all of which makes for a less healthy labor and birth. On top of this, rates of mothers requesting birth interventions, including c-sections on demand[18] are up. The above issues are not all linked to the type of care provider a mother chooses. Some argue that midwives may help lower the complications above because midwives do tend to spend more time with patients, thus may be able to encourage a woman to eat healthier, exercise and stay healthy. However, traditionally, midwives care for women having low-risk pregnancies. For example, if you’re overweight, older or have heart disease or diabetes, you may be ineligible for midwife care[19].

Midwives are an excellent choice for women, but it’s not entirely clear if simply having the option of choosing a midwife will help normalize maternity care, unless future mothers-to-be also get on board with healthier habits. Learn about some of these healthy habits in the links below.